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D.-U. G. Bartsch, L. Dustin, S. P. Azen, W. R. Freeman; Correlation Between Structural and Functional Measures of Vision in Patients With HIV. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4857.
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HIV patients without infectious retinitis have been shown to have vision loss. This vision loss can be measured by contrast and color vision testing, visual fields and electrophysiology. We have recently found that a structural basis of this can be demonstrated by evaluation of nerve fiber and optic disc morphology. We wished to evaluate the relationship between morphological changes in retinal nerve fiber layer and functional measures such as vision, quality of life as well as CD4 nadir in HIV patients without retinitis.
To evaluate the structural basis of vision loss in HIV patients without retinitis we analyzed 148 eyes of 75 subjectsevaluated at the UCSD Jacobs Retina Center. Our study population consisted of three groups. Groups A and B were HIV positive patients without current or past infectious retinitis. We further sub-divided these patients based on reported CD4 count of never below 100 (HIV high) and those who did present at one point with a CD4 nadir of below 100 (HIV low). The third group was HIV negative normal controls. Serial blood work yielded such results as CD4 nadir. Functional measures include vision quality of life (VFQ-25), ETDRS visual acuity, contrast sensitivity testing, Farnswell-Munsell 100 Hue color testing, and multifocal ERG. Structural measures include peripapillary OCT imaging (StratusOCT), and RNFL polarimetry (LDT GDx) and scanning laser tomography (HRT). These measurements were performed on each patient/eye in a prospective study.
Among the structural measures we found a significant difference among the groups in OCT and polarimetry measures. Among the functional measures we found a difference between normals and both groups of HIV positive subjects in VFQ score and MD and PSD HVF test. We found a significant correlation between VFQ-25 and color test score as well as between VFQ-25 and HVF scores.
Structural changes seen in the retina of HIV patients without retinitis are present and predict visual function loss. They may be a useful measure of lifetime HIV burden. There is a significant correlation between structural changes and function including quality of life. Further longitudinal studies are on-going.
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